Revitalizing family medicine: How to strengthen the specialty
■ A new report from a coalition of family physician groups offers a blueprint.
Posted May 17, 2004.
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The writing was on the wall and it spelled extinction for the practice of family medicine.
The most striking indicator: U.S. medical school graduates picking family practice residencies had dropped 50% since 1997 as students sought specialties with more pay and fewer hours. Meanwhile, there is no shortage of discontent among practicing family physicians, also largely tied to low pay and long workdays.
So, in 2002, seven national family medicine organizations launched the Future of Family Medicine to examine ways to help the specialty evolve in the 21st century. The FFM report, released in late March, is an ambitious plan that offers recommendations to provide a framework to guide innovation in three key areas -- medical education, clinical practice and the U.S. health care system.
The participating organizations are a veritable who's who of the specialty: the American Academy of Family Physicians, the American Academy of Family Physicians Foundation, the American Board of Family Practice, the Assn. of Depts. of Family Medicine, the Assn. of Family Practice Residency Directors, the North American Primary Care Research Group and the Society of Teachers of Family Medicine. Each of these organizations has assumed responsibility for enacting the recommendations that fall within its purview.
To give the FFM further clout, the report has received declarations of support from many other organizations of medicine, including the American Medical Association. Back in 1966, the AMA published two reports that called for the reinvention of the generalist function in medicine and for general practice to become family medicine. The AMA says the FFM report "preserves the core values of the specialty while creating a blueprint for the future."
Yet despite its support within organized medicine, the report runs the risk of being cast aside by the very physicians who must implement certain recommendations if the future of family medicine is to be secured. These physicians will look at the new model of care recommended by the project and decide that with its electronic medical records, Web portals, and e-mail systems for patient communication, that it is too expensive to implement. They will rightly point out that on its face it seems to ask them to do more without being paid more.
They should not be too hasty. The FFM recognizes that under the current health care system practice resources are insufficient to implement many of the ideas it outlines for transforming the health care system. It has appointed a task force to develop recommendations regarding reimbursement and financial models for family practice. The task force is expected to issue a report in fall 2004.
FFM task force members are not alone in acknowledging the link between their specialty's survival and pay. The Society of General Internal Medicine, which recently released a plan for revitalizing its specialty, will also examine restructuring reimbursement.
Family practice has already transformed health care once. Since its creation nearly 40 years ago, family physicians have been providing front-line medical care to people all across the country from all economic backgrounds. In 2001, office visits to general and family physicians numbered more than 210 million.
With its call for a personal medical home for patients with care provided through a multidisciplinary team approach, its endorsement of lifelong learning for physicians and its quest for a viable reimbursement and practice financial model, the Future of Family Medicine project offers a second opportunity for transformation. It deserves the time and support necessary to move from grand idea to thriving reality.